Perkins played a brief musical cameo on the street outside Aretha's Soul Food Cafe in the 1980 movie The Blues Brothers, having an argument with John Lee Hooker over who wrote "Boom Boom." He also appeared in the 1987 movie Angel Heart as a member of guitarist Toots Sweet's band.

Perkins was driving his automobile in 2004 in La Porte, Indiana, when his car was hit by a train. The car was wrecked, but the 91-year-old driver was not seriously hurt. Until his death, Perkins lived in Austin, Texas. He usually performed a couple of nights a week at Momo's, on Sixth Street.

The song "Hey Mr. Pinetop Perkins", performed by Perkins and Angela Strehli, played on the common misconception that he wrote "Pinetop's Boogie Woogie":

On March 21, 2011, Perkins died at his home in Austin, Texas.[6] At the time of his death, he had more than 20 performances booked for 2011. Shortly before he died, while discussing his late career resurgence with an interviewer, he conceded, "I can't play piano like I used to either. I used to have bass rolling like thunder. I can't do that no more. But I ask the Lord, please forgive me for the stuff I done trying to make a nickel."[7] He and David "Honeyboy" Edwards were the last surviving original Delta blues musicians. Perkins was also one of the last surviving bluesmen to have known Robert Johnson.[7]